Healthcare Provider Details

I. General information

NPI: 1134869191
Provider Name (Legal Business Name): RECONSTRUCTIVE SURGERY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR FL 6
BEVERLY HILLS CA
90210-4416
US

IV. Provider business mailing address

PO BOX 15868
BEVERLY HILLS CA
90209-1868
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-5275
  • Fax: 631-629-2559
Mailing address:
  • Phone: 310-880-5275
  • Fax: 631-629-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. URMEN DESAI
Title or Position: OWN/PRESIDENT
Credential: MD MPH
Phone: 310-880-5275